NSMS Admissions – 10-Lesson Chamber Music Package

Chamber Music Student Registration

10-Lesson Chamber Music Package
You will receive a confirmation email once we receive your registration. Please contact admissions@nsmspiano.org if you do not receive a confirmation email after submitting.

Please note that scheduling is dependent upon availability and demand.
Student Name*

First NameLast Name
Instrument*
Years of Lessons*
Please indicate how long the student has been playing.
Student Gender*
Student Birthday*

MonthDayYear
Date
Student's Current School
Parent Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Parent Occupations / Adult Student Occupation*

Are you interested in additional performance opportunities? (Silent Film Celebration, community events, etc.)*

YESNO
Do you have other family members currently enrolled at NSMS?*

YESNO
If yes, please enter the first and last names of those family members.*

LESSON AVAILABILITY: Please list all available times.*

	Range of Available Times
Thursday
Saturday

POLICIES

Make-Up Lesson Policy

Make-up lessons are not guaranteed. However, if a student misses a class, the assignment or materials will be sent to them so they can stay on track.
Please check the boxes below.*

I agree to the make-up lesson policy.
Photograph and Video Usage Consent

With your consent, photographs or recorded video of your/your child's piano lessons or group classes may be used and reproduced as part of teacher education resources for the Frances Clark Center for Keyboard Pedagogy, without compensation to you. You/your child will remain anonymous. Your/your child's first name may be stated during a video if it occurs as part of the interaction during the lesson/class. Student surnames will never be mentioned or published alongside a video or photograph.

The Frances Clark Center reserves the right to use the photographs and videos in any of its print or online publications and advertisements. All resultant photographs, digital images, video files, and related media are owned by The Frances Clark Center. Please check the box below:
I hereby consent to authorize The Frances Clark Center for Keyboard Pedagogy to use photographs and video of my/my child's piano education activities.
Payment

My Products*

Ten 45-Minute Chamber LessonsMusic and materials will be provided.

$350.00

Enter coupon

Total

$0.00

Chamber Music Student Registration